Health care in Ontario is cracking under stress

TheStar.com – Opinion/Editorial Opinion – Because of government neglect, the entire health-care system is unravelling at the seams, writes columnist Bob Hepburn.
Published On Thu Aug 05 2010.   By Bob Hepburn, Editorial Page

Premier Dalton McGuinty loves to brag about the progress his government has made in changing the health-care system in Ontario.

That was reinforced last week when his health minister, Deb Matthews, staged a news conference to boast about how some hospitals are reducing wait times and to pledge extra money to hire more staff and buy more high-tech equipment for emergency rooms.

But both McGuinty and Matthews are strangely silent these days about community and home care, one of the most critical parts of the health-care system that’s becoming a province-wide nightmare.

Indeed, because of government neglect, the entire health-care system is unravelling at the seams.

Since coming to power in 2003, McGuinty has promoted a shift in the delivery of health care away from hospitals and institutions and toward providing more care in the community and at home.

It’s a laudable move.

However, the government has failed to adequately fund such programs, resulting in tens of thousands of patients receiving fewer and fewer visits from trained professionals in their community or homes — or going without services at all.

And the problem is expected to grow worse — not better.

That’s because hospitals, in response to Queen’s Park budget restraints, are moving patients out faster than ever, while simultaneously trimming the number of beds, services and staff.

Unfortunately, there is not enough money being provided to the agencies that deliver health care in the community and in homes to manage the increased demand for services.

So Community Care Access Centres (CCACs), the government agencies charged with coordinating health services in the province, have been forced to refer only the most needy cases for help.

That means other outpatients who need services such as occupational therapy or speech-language therapy must go without or pay by themselves for private service.

Evidence of the cuts is clear:

Home visits by occupational therapists dropped 24 per cent in the 2008-09 fiscal year over the same period a year earlier.

Visits by physiotherapists were down 9 per cent.

Visits by dieticians were off 2 per cent.

Visits by speech-language pathologists plunged a whopping 40 per cent, from 461,484 in the 2007-08 fiscal year to 274,068 visits in the last year.

A Toronto agency that provides therapists for outpatients received 40 per cent fewer referrals for adult physiotherapy this June than in June 2009.

The list goes on.

Such declines are nuts.

Surely just as many patients need such services this year as last year.

That’s especially true when you consider that in recent months major institutions such as Holland Bloorview Kids Rehabilitation Hospital and Credit Valley Hospital in Mississauga have either laid off rehab professionals or slashed their rehab programs, thus forcing more and more patients to seek services in the community.

On Tuesday, the Canadian Medical Association released a report calling for sweeping changes in the health-care system, including increased investment in community and home care. It noted that hospitals are now focusing mainly on patients who are acutely ill, closing their clinics that provided such services as rehab, physio and occupational therapy.

The CMA warned that the widespread scarcity of home-care services means that care for many patients is compromised.

Susan VanderBent, executive director of the Ontario Home Care Association, an organization of home health and social care service providers, said in an interview that home-care spending as a percentage of total Ontario health expenditures is less now than in 1998 under the Mike Harris government, when it was 5.43 per cent.

“We are working to ensure that people in Ontario still have a full range of services, even if they are no longer provided in a hospital setting,” she said.

“And those services need to be more than just a bath a week, especially if for example what you also need is physiotherapy after hip surgery.”

Because of the sudden drop in patient referrals from CCACs, many of the private firms that link patients and CCACs with health professionals are struggling to survive.

Many have already laid off administrators, therapists and other professional in a frantic bid to stay afloat. And they warn of more layoffs to come.

In response to the sharp decline in patient referrals, VanderBent’s organization will hold a round table meeting of all its members in September to research ways to raise public awareness of this problem.

So what can be done?

As a first step, Matthews and McGuinty should take the advice of the Ontario Home Care Association and conduct a detailed study of the recent cuts by CCACs in referrals of patients.

The next step would be to listen to the people on the front lines, those who actually provide service to patients on a daily basis.

In that vein, Matthews is to meet next week with VanderBent and senior members of her association.

She would do well to listen very closely because the health of everyone who needs help in Ontario is at stake.

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